Financial anchor year: FY25. Margin and revenue are as filed for FY25. Days cash on hand is FY23, the most recent year that passed the display gate. Every tile below states its own fiscal year; nothing is carried forward or estimated.
The read
A hospital in Deadwood, SD. It ran an operating loss of 3.0% in FY25 on $19.4M of operating revenue. It held 7 days of cash on hand in FY23, its most recent reported liquidity (17th percentile of 1,319 Critical Access Hospitals on liquidity, FY23 pool). Operating margin improved from -9.8% in FY21 to -3.0% in FY25. Including nonoperating items, the all-in result was positive at 5.6%.
Operating margin · FY25
-3.0%
Astrelis calculation · as-filed inputs
vs Critical Access Hospitals41st pctl of 824 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Days cash on hand · FY23
7d
all sources
Astrelis calculation · as-filed inputs
vs Critical Access Hospitals17th pctl of 1,319 (FY23 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Total operating revenue · FY25
$19.4M
Astrelis calculation · as-filed inputs
vs Critical Access Hospitals26th pctl of 833 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Total margin · incl. nonoperating · FY25
+5.6%
Astrelis calculation · as-filed inputs
vs Critical Access Hospitals46th pctl of 824 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
One point of operating margin at MONUMENT HEALTH LEAD-DEADWOOD HOSPITAL is about $194K per year (1% of FY25 total operating revenue).
Where MONUMENT HEALTH LEAD-DEADWOOD sits among Critical Access Hospitals
Operating margin · FY25 pool · n = 824 of 1,399 filed
Each point is one Critical Access Hospital in the national FY25 distribution for this provider type, placed by operating margin. Facilities are not matched on size, case mix, or market; that is the matched-peer comparison in the paid benchmark. The Critical Access Hospital FY25 median is -0.2%. Descriptive context only, not a ranking.
One critical access hospitalMONUMENT HEALTHCritical Access Hospital median
The money
$ thousands · HCRIS cost-report basis · as filed, QA-gated
Ratios tell you how this hospital is doing. Statements tell you what kind of organization it is, and where the money comes from. Every figure below traces to a public cost-report filing, shown as filed. A ratio computes only when every input is reported in the filing (otherwise its cell states which input is Not reported in source); a year whose balance sheet does not reconcile is labeled, and its derived ratios read Astrelis calculation unavailable. Not audited by Astrelis.
Net patient receivables ÷ (net patient revenue ÷ 365), same fiscal year
Astrelis calculation · HCRIS WS G / G-3
Medicare inpatient contribution margin
+48.5% (FY24)
Full comparison in the CAH Performance Benchmark.
HCRIS cost report · CAH economics engine
Medicare outpatient contribution margin
+43.8% (FY24)
Full comparison in the CAH Performance Benchmark.
HCRIS cost report · CAH economics engine
$ in thousands
Line item
FY23
FY24
FY25
Patient revenue
20,244
17,451
19,247
Other operating revenue
3
126
115
Total operating revenue
20,247
17,577
19,361
Total operating expenses
20,363
18,241
19,943
Operating income
(116)
(664)
(582)
Operating margin %
-0.6%
-3.8%
-3.0%
Grants & contributions
40
—
0
Other non-operating, net
1,352
1,197
1,773
Net income
1,276
533
1,191
Net income %
+5.9%
+2.8%
+5.6%
— = Not reported in source for that year.
HCRIS Worksheet G-3 / S-3 · $ thousands · FY21–FY25 · where other operating income is not reported, total operating revenue reflects net patient revenue alone · FY20–21 may include COVID-era relief funding in nonoperating income
Display states.FY25 · Days cash on hand — Astrelis calculation unavailable (the corrected series carries no computable value for this year)FY24 · Days cash on hand — Astrelis calculation unavailable (the corrected series carries no computable value for this year)FY22 · Days cash on hand: -39 days — Astrelis calculation · outside expected range; shown at the chart boundary and included in peer statistics (out of display range)
How it operates
quality & operational context · CMS public reporting
A 16-bed hospital running at 11% occupancy, where swing beds are 74% of the inpatient business, and 76% of patient revenue is outpatient.
The metrics this hospital type is judged on: care quality, patient experience, and scale. Each is labeled by provenance class and public source; descriptive context only, never a ranking or adequacy claim. Provenance labels: Reported value is copied from the named public source; Astrelis calculation is a formula applied to unchanged reported inputs, with the formula shown; Illustrative estimate is a benchmark gap, multiplier, or scenario — never a measurement.
Scale and flow
Occupancy
11.3%
Reported value2025
HCRIS WS S-3
Average daily census
1.82
Reported value2025
HCRIS WS S-3
Staffed beds (acute)
16
Reported value2025
HCRIS WS S-3
Annual discharges
191
Reported value2025
HCRIS WS S-3
Average length of stay
3 days
Reported value2025
HCRIS WS S-3
Cost per patient day
$30,126
Astrelis calculation2025
Astrelis calculation — total operating expense ÷ total patient days (HCRIS WS G-3 / S-3)
Cost per discharge (unadjusted)
$104,416
Astrelis calculation2025
Astrelis calculation — total operating expense ÷ discharges, NOT case-mix adjusted (adjusted discharges are not on the public filing set)
Swing-bed average daily census
5.09
Reported value2025
HCRIS WS S-3 L5–6
Swing-bed share of inpatient days
73.7%
Reported value2025
HCRIS WS S-3 (acute + swing days)
Outpatient share of patient revenue
75.9%
Reported value2025
HCRIS WS G-2 L28
How the care measures up
C. difficile infection (SIR)
Not reported in source (note 1)
CMS-reported measure07/01/2024 to 06/30/2025
CMS Care Compare
Hospital-wide unplanned readmission
14.5%
No Different Than the National Rate
CMS-reported measure07/01/2023 to 06/30/2024
CMS Care Compare
Note 1: Results cannot be calculated for this reporting period.
Commercial negotiated rates as a percent of Medicare rates, outpatient basket. Chart bound 300%; values beyond it are clipped at the bar edge and shown at their actual figure.
Hospital price files + Medicare rates
Directional indicator from public price files. Facility-specific rate positioning is the Commercial Pricing Study →
Trajectory
Cost-report basis · 5 reporting years
Operating margin
Days cash on hand
The county this hospital serves
LAWRENCE County, SD
Median household income
$66.8K
vs $82.1K US · $59.7K rural median
Poverty rate
11.8%
vs 12.5% US · 14.3% rural median
Uninsured
10.9%
vs 8.6% US · 8.4% rural median
Age 65+
24.1%
vs 16.8% US · 20.6% rural median
Fair or poor health
16.4%
self-reported, adults · CDC PLACES
Primary-care shortage
Not designated
HRSA HPSA
Economic context: 6.0% of county personal income is Medicare/Medicaid medical benefits; 18.1% arrives as government transfers (BEA, 2022).
Illustrative advocacy scenario: what this hospital means to Lawrence County
Illustrative estimate · FY25 cost report
Direct annual spending
$19.9M
total operating expense · Reported value, not a local-capture estimate
Economic activity
$45.9M
direct spending × 2.30 · AHA national hospital economic activity report — a national hospital ratio, not a CAH or county figure · Illustrative estimate
Employment and labor income multipliers are from the National Center for Rural Health Works 2016 study of Critical Access Hospital economic impact (IMPLAN Type II, U.S. rural county populations); the economic-activity ratio is from the AHA national hospital economic activity report and describes U.S. hospitals as a whole; it is not a CAH-specific or county-specific figure. Applying any of these to an individual facility is an illustrative advocacy scenario, not a measurement: local capture depends on payroll residency, purchasing patterns, and county economic structure the sources do not observe. This facility is a critical access hospital, the NCRHW study population. Direct figures are reported values from the facility's HCRIS cost report. Want a defensible facility-specific figure? Request a Facility Economic Impact Study →
Medicare inpatient contribution marginFY24Astrelis calculation from reported HCRIS inputs
+48.5% (FY24).
The Board Briefing
What changed, what matters, and what your board should ask — every figure sourced to the public record.
CAH Performance Benchmark: FY25 peer pool · n = 824 · conservative low band; acuity limits stated in the report.
Basis: 86 services in the basket · 11 classified commercial payers (77% of commercial volume classified) · pricing files captured 2026-07-19 · numerator: negotiated commercial allowed amounts (classified payers) · denominator: Medicare OPPS-equivalent for the same services · weighting: volume-weighted line-level outpatient service basket (CY2026 OPPS equivalent) (weight coverage 88%).
Report coverage: Limited Facility Benchmark. 14 of 17 facility measures available from public sources. The report covers the available measures against their peer benchmarks; measures the public record does not carry become findings. Coverage is disclosed here before you reserve, and thin data is never a decline reason. The refund guarantee stands: if we cannot deliver the published scope, you pay nothing.
The Board Briefing
Your facility and its world, board-ready. Measures the public record does not carry become findings, never a decline reason.
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